Provider Demographics
NPI:1215929179
Name:HENKEN, H. BRAD (DO)
Entity type:Individual
Prefix:DR
First Name:H.
Middle Name:BRAD
Last Name:HENKEN
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 GOOD HOPE ROAD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ENOLA
Mailing Address - State:PA
Mailing Address - Zip Code:17025-1233
Mailing Address - Country:US
Mailing Address - Phone:717-791-2680
Mailing Address - Fax:717-791-2686
Practice Address - Street 1:1824 GOOD HOPE ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:ENOLA
Practice Address - State:PA
Practice Address - Zip Code:17025-1233
Practice Address - Country:US
Practice Address - Phone:717-791-2680
Practice Address - Fax:717-791-2686
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007510L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014475040004Medicaid
PAHE758321OtherHIGHMARK BLUE SHIELD
PA02101201OtherCAIC
PA0014475040004Medicaid